Hi, everyone. In today’s video, we’re going to talk about listening to music during labor for pain relief. My name’s Rebecca Dekker. I’m a nurse with my PhD and the founder of Evidence Based Birth. I’m also an amateur musician. I grew up playing piano and flute. I had piano scholarships in college, so this is a topic that I was excited to explore the research about.

First, I wanted to talk a little bit about music therapy in general. The field of music therapy is a relatively new, non-drug way of promoting the well-being of people of all ages who are both sick and healthy. Music therapy is used in both the clinical setting and the home setting to prevent and treat a wide variety of conditions ranging from acute and chronic pain to brain injuries.

How might music therapy work to promote comfort and reduce pain during labor?

Researchers think that listening to music during labor might change how a person perceives pain by decreasing its unpleasantness. According to something called the Bonapace and Marchand Classification, music acts through the higher centers of the central nervous system (called the CNSC mechanism) to relieve pain. These parts of the brain are closely associated with memory and emotion. It’s thought that listening to music during labor might activate mental processes that make labor sensations more comfortable or less uncomfortable. Researchers also think that music might work by stimulating the pituitary gland inside your brain to release endorphins and increase levels of serotonin, a neurotransmitter. Listening to music during labor may also promote pain relief by helping you relax, reducing anxiety, and providing a positive source of distraction during labor.

What is the best music to listen to for relaxation?

In 2012, researchers published a paper that looked at what makes the best music for relaxation during labor. 14 music therapists recommended and analyzed 30 selections of music. Then, a group of 80 healthy adults listened to the music and rated it based on how it made them feel.

They found that there are certain intrinsic properties in music that make music relaxing. These include tempo, harmony, rhythm, instruments, melody, voices, and pitch. An important finding from this study was that people’s familiarity with music and their preferences for music were strongly linked with how relaxed they felt when they listened to the music. In other words, music is personal. There are some objective qualities that make music relaxing, but music is also very subjective and something that might be relaxing for me, might not be relaxing for someone else.

I once had a friend give birth who was an opera singer. She told me afterward that she listened to her favorite opera music throughout her labor. She said that she literally did not feel pain during contractions. She didn’t train in self-hypnosis or any other technique that would help her to have a painless birth, so I was really curious about what the evidence is on listening to music during labor.

What is the evidence on listening to music during labor?

2018 Cochrane Review and Meta-Analysis

Well, in 2018, researchers published a Cochrane review and meta-analysis all about relaxation techniques for pain management during labor, and they included studies that looked at music. They found three randomized, controlled trials that compared people who received music during labor versus those that who did not get music during labor in three different countries. In two of the studies that looked at this outcome, they found that women reported a lower pain intensity in early labor if they were listening to music compared to those who were randomly assigned to not get to listen to music. However, they found no clear benefit to the music during the active phase of labor. There was no evidence of a benefit of music on anxiety in the early stage of labor or the active phase. However, one study did find that during transition, music did lower people’s anxiety levels. None of these three studies looked at participant satisfaction with pain relief, their sense of control, or their overall satisfaction with the birth.

Hollins Martin (2014) Review

Another review was published in 2014. This review looked at five studies that examined the experiences of women who listened to music during labor. In all five of these studies, the participants were having unmedicated birth, so they were not having pain medication. They found that in four out of the five studies, music did improve women’s experiences compared to having no music. For example, in one of the studies that was published in 2003, 110 mothers in Thailand were randomly assigned to have either three hours of soft music without lyrics during active labor or to have no music. The women who were given the soft music reported significantly lower pain scores.

Recent RCT from Turkey

There was also a randomized, controlled trial published in 2018 that was too new to be included in the Cochrane review. In this study, they looked at 50 healthy, first-time mothers who were giving birth without pain medication at a hospital in Turkey. They were randomly assigned to give birth while listening to a specific kind of Turkish music called Acemasiran mood music, (I hope I pronounced that correctly), during active labor or no music, which was the control group. The music group listened with their earplugs for three hours. They would have 20 minutes of listening and then 10 minutes of breaks. None of the participants refused to listen to the music. They all kept listening.

There was no significant difference found in their pain scores before the intervention or after the first 30 minutes. But, they found that the music group had significantly lower pain scores after the first hour of listening to music during labor and every hour after that. Even after the music intervention ended, so after the three-hour intervention was over, the music group continued to have lower pain scores compared to the control. On average, the pain scores continued to be about one point lower even after the intervention was done.

They also found that the average anxiety level of the music group was significantly lower when compared to the control group after the music intervention was done. The researchers also surveyed the women one hour after the birth and they found that all 25 mothers in the experimental music therapy group said that they liked listening to the music during labor. When they were asked to rate how difficult their labors were, the experimental group with music rated their labors as less difficult on average, 6.6 compared to 8.1 in the control group. Out of the mothers who listened to music, only three women said that they did not find music effective for relieving pain.

Entrainment and Binaural Beats

Another type of music that we don’t have a lot of research on yet, at least when it comes to childbirth, is something called entrainment and binaural beats. I hope I’m pronouncing that correctly. The definition of entrainment is your body’s ability to respond to and synchronize its internal state with the external environment, including sound and rhythm. Then, the music slowly progresses to a more relaxing tempo in order to promote relaxation.

Another music therapy method is to use binaural beats. Binaural beats happen when both ears receive two tones that are slightly different frequencies simultaneously. This produces a beat where the frequency equals the frequency difference between the two tones, called an acoustic beat. With binaural beats, the two tones with slightly different frequencies are delivered one to each ear, so you have earbuds in and you get slightly different tones in each ear, and your brain actually generates a beat that is equal to the difference in the frequencies, and that’s the binaural beat. You can search on YouTube for all kinds of videos that demonstrate binaural beats.

Researches think that binaural beats might alter your brain waves, although this is controversial with different studies finding different results. The evidence on binaural beats is conflicting, but it’s important to remember that music is more than just sounds. Music is inherently emotional and it probably has benefits that are independent of just strictly different types of sounds and frequencies.

In conclusion, the studies on using music during labor for pain relief are mixed, but for the most part they seem to find benefits. There’s evidence from two randomized trials that music helps to relieve pain during early labor. There is also evidence from one trial music may help during the transition phase of labor. A recent study, although small, of 50 mothers from Turkey found that music lowered pain scores and continued to lower pain scores even after the music had stopped. In addition, it also lowered anxiety.

Of course, one limitation in all these studies is that the people in the study know which group they were assigned to. So, there’s something called a Hawthorne effect in research where pl who know they’re getting the intervention might be more likely to have a beneficial effect because they know that that, they’re supposed to have a beneficial effect. With music, it’s impossible to blind people to whether or not they’re having music or no music.

Since music is stimulating to your central nervous system and effects your memories and emotion, people probably find music more beneficial if they select it themselves. Or, on the other hand, they can train themselves to relax to a certain type of music and to have positive thoughts, and emotions, and feelings when they’re listening to that music and then use that same music during labor. Some people may prefer classical music. Other people may prefer something that’s more personal to them.

For example, my friend who’s an opera singer, I wanted to give you a shout-out. She chose music that was incredibly personal to her and that she was extremely familiar with. And again, one study has found that your familiarity and preferences for music are strongly linked with how relaxing you find music to be. The bottom line is that using music for pain relief during labor has benefits and it’s free, and doesn’t seem to have any side effects. It my improve the experience of child birth by lowering anxiety, potentially lowering pain, and promoting a sense of relaxation.

My research assistant, Anna Bertone, and I put together the script for this video, along with help from Kate Taylor, a board certified music therapist. We just wanted to say thank you, Kate, for all your help, and thank you everyone for watching and listening. If you enjoyed this video, please hit subscribe to subscribe to our videos and be notified when they come out. Also, I’d love it if you could check out the other videos in our pain management series. That’s it for this week. Thanks, everyone. Bye.